HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A\\aN 1 Permit Number: (3-aM
RECEIVED SEP 21 B17
AN
Building Permit Application SC BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce A34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Ccw. en 4c III
Address: atD.'3 S. Kirg HIN4, &r-r Fie'.rcn, FL 54P'iS
Legal Description: First Source Commerce Park Condominium (pQ. a�iaa— 171 () n (+ 'P_ 11 a
PhQ';P. a C-0Q .31WA-la6Q)
Property Tax ID #: oj,"�I I — Pd)n - 00 ac:j - OC)n -8 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
OrywoA removal and repiacemefw, insulation removal and coniocanen
paint, interiordoor repacementr CDrywall replaced up -to a' above
CONSTRUCTION INFORMATI N:
rtiona wor to a er orme under tis permit —check all app y:
IIHVAC Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ C;. CC0.0C) Utilities:SewerSeptic Building Height:
El
01/UNER%LESSEEr y „" : „
CONTR/ACTOR:.
Name JnhnSC]rl—DQvi�ne.
Name: MichaelJ.Waldrop
Address: (120J Hilibria+h Drive_
Company: Innovation Contracting, Inc.
City: Lanfain0- State: E(,
Zip Code: 3%i4Lo a Fax:
Phone No.
Address: P.O. Box 12757
City: Fort Pierce State: FL
Zip Code: 34979 Fax: N/A
Phone No. 772-519-9108
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: mwaldrop@innovationcontracting.com
State or County License: CGC1511910
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
INrRIn Y Y'yTSF^g
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip:
Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will'authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemeggto your property. A Notice of Commencement must be orded and posted on the jobsite
before the list inspection. If you intend to obtain financing, consult th lender or an attorney before
commen � ne work o1 recordine vour Notice of Commencement. _
as Agent for Owner
STATE OF FL
COUNTY OF
The or oing instrum t w ac nowledgW before me
this day of 20 by
ame of person making statement
Personally Known OR Produced Identification
Type of Identifi a ioJi
Produced � '
(Signature of Norly Public -State of Florida )
Aur.Fi A M HUFli
Notary Public - State of Florida
Commission # IF 234730
Rev.8/2/17
REVIEW
STATE OF FC@RtIIA )
COUNTY OF
The
me
'Name of person making statement
Personally Kn wn OR Produced Identification
Type of Id
en i r ajion /
Produced / /
(Signature of Noory Public -State of Florida )
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW